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Hello, sports fans. Have you missed me? It’s been about five days since I posted a comment that didn’t follow an article authored by someone else.

My last one was “Pruitt’s Platform – Introduction to an Adventure.” It’s unusual for me to go so long between posting stand-alone pieces, but after putting that title to my introduction, and compounding the challenge by promising to never push out bland stuff, I set my standard high. It took me a few days, but I finally found a deserving old target on a brand new venue that I think will hold your interest. BCBSTX and I have an intense history, so I assume they charged someone anonymous and shy to follow everything I write. I welcome you, whoever you are. Yea, you. The one hiding in the dark corner, justifiably afraid to utter a peep. Keep your pointed head down, friend, and try not to wet your nice pants.

BCBSTX, you should be disappointed to learn that I found your Facebook account. Even for a fat dinosaur, you are an especially thick and slow-moving easy target. I recommend you just surrender now to transparency and start the confessions and reparations before the lawsuits become huge and the lawyers profit more from your collapse than the Texan dental patients you’ve harmed. Let me remind you that the repeal of the McCarran-Ferguson Act is just around the corner, and we all know about the rumor (started by me) that there are attorneys across the nation just waiting to file class-action lawsuits against BCBS for unfair business practices, including restraint of trade for using the NPI number to drive satisfied patients from dental homes they preferred. Finally, BCBSTX will be subject to the same anti-trust laws as the doctors they fear, and I am here to make sure BCBSTX feels the pain. Look what happened to Dell Computer when that huge dinosaur was surrounded by Jeff Jarvis and Dell Hell. The game I’m playing with you is a more nimble, improved variation of Dell Hell, using fewer vulgar words.

You should know by now you are too fat and too slow to hide from me and the sports fans I bring. Nevertheless, I am always fair in telling my targets my goals before I go on to accomplish them. Here is what I am going to do to you, BCBSTX: I intend to pull your anonymous, unaccountable butt out into the wide open for everyone to see – especially the lawmakers you lobby and support with generous donations. Did you know that there is a rumor (also started by me) that some of those same lawmakers you consider friends are aware of most of what I write on the same day I post it? The transparency I bring will eventually trap and crush you, BCBSTX. Or, you can immediately come out and meet me for an open discussion about the inevitable reformation of dental insurance in Texas – putting humble, obedient bureaucrats with names under the direct control of dentists and patients. And of course, it is understood that in order to save Texas citizens millions of dollars in healthcare expense, there will be drastic downsizing of BCBSTX Dental, just like Delta Dental and ADA/IDM are experiencing right now. That means no more bonuses and no more frivolous pursuits like publishing, printing and mailing to Texas dentists those expensive self-serving brochures joyfully titled “NPI Times.” I suggest you get your resumes in order, BCBSTX employees. I’m very good at having my way with archaic business models. Others I have attacked, such as ADA/IDM and Delta Dental, are clearly failing. Coincidence? Perhaps you’d like to tell yourself that when I undermine your support every time you come up for air. Why not send out your sharpest PR specialists? Oh please, would you? Also, equip them with committee-approved talking points that I’ll hang around their necks for a long time.

When I discovered that BCBSTX had a Twitter account, I started asking anonymous employees of BCBSTX about their new NPI number requirement for processing dental claims – even for dentists who have no contractual relationship with the company. But rather than answer a dentist’s questions about their dental policy (incredibly stupid, BCBSTX), the leaders of the command and control company who can no longer command or control their own socks, responded by blocking me from following them. That was irresponsible, childish behavior from one of the largest and most powerful dental insurance companies in the state. Shouldn’t it be important for BCBSTX to respect dentists who must deal with their cumbersome rules?

At a time when managed care dental companies like BCBSTX are lobbying Congress hard to preserve their taxation subsidy, I think it is important for lawmakers to recognize that these huge stakeholders neglect the welfare of those they serve: the principles – dentists and their patients. We are your constituents who count, Congress. Not discount dentistry brokers whose products will not sell in the free market without mandates and taxpayer assistance – simply because they are lousy products.

If BCBSTX had not opened a Facebook account, I would not have opened one myself. I discovered my fat, defenseless opponent when I googlesearched “BCBSTX” the other day. On their first page was the link “What is the NPI number of BCBSTX? – Facebook.” It features a client’s naïve, insignificant question about the NPI number, and it opened the door for my informed, significant one which I copied below, as well as posted on Twitter.

By the way, I was disappointed to see that my comment “BCBS-TX Dental Insurance is Rude to everyone,” which I posted on the Medical Executive-Post over three months ago, was no longer on BCBSTX’s first page. It was their third hit for weeks. But since I hadn’t given the comment a bump lately, it has dropped down to the bottom of their second page. Can’t have that! If you don’t mind, please click once or more on the following link and stay there a few minutes. That way, it will push the blunt criticism back up onto BCBSTX’s first page and will once again warn potential clients of BCBSTX’s poor business ethics. If you’re going to be there anyway, why not go ahead and read the sucker? You could find it interesting. Lots of people do.

As I wrap up this comment, I’ll share with you with the question I left BCBSTX on Facebook almost 6 hours ago concerning their NPI policy. I don’t think Facebook was a good idea for BCBSTX leaders. Sit back and watch me get someone fired today.

Dear BCBSTX:

I would like to point out to readers more information about the NPI number which you are not likely to share. If you have BCBSTX dental insurance, and your dentist does not have an NPI number, BCBSTX will not process your dental claim and the premiums you will have paid to BCBSTX will become unearned profit for BCBSTX.

Is that true, BCBS-TX? Yes or no?

Conclusion

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19 Responses

I was considering possible topics to write about on this humid July morning when tangible interest in my Twitter monologue appeared and carried me several months back to the ADA Headquarters in Chicago as described in the first edition of “Road Trip IV,” which until now, I have only shared with my private network between 8/13/09 and 8/27/09. It was unfinished at the time. Don’t be surprised if the adventure story is still unfinished when I pause from writing this second edition. I can do that.

Evidently, at least three people I don’t know, @ralpha83, @beatlesp23 and @ mollyb61, shared my Twitter comment “[Dr. Anderson] said Delta data-mined 11 years of claims to discover this, but added that the data can’t be released because of competition with BCBS.” Mkelley was upset that they failed to attribute the remark to me, I suppose.

I responded, “I appreciate @mkelley’s concern that I get credit, but it’s really no big deal. I’m just happy to know its got legs. Won’t Max be surprised!”

This little excursion started yesterday morning, July 4th. It was not out of character that I started ranting on Twitter about the unresponsiveness of Delta Dental’s top leaders. And as is commonly the case, I didn’t really care if anyone was following or not. I pointed out that Twitter is like a snapshot of the event horizon that fades fast. As I explained to the estimated crowd of three, the lack of permanence of tweets is one of the characteristics that appeals to me. It gives me a safe place to float my ideas to see what works and what doesn’t. Twitter is like a small nightclub where I can practice my shtick before taking it on the road for discerning readers like you. It offers subtle feedback from a small slice of a niche audience way out on the long tail of a Bell curve – a natural phenomenon of probability dispersion of a population’s characteristics first recognized by Alexander Graham Bell. (I remember this because I’ve also noticed that when it is plotted out on a graph, it often resembles the shape of a bell).

My quirky, esoteric audience this Sunday morning seems to be interested in Delta Dental’s data-mining of dental claims – one of yesterday’s topics I have already referred to.

It just so happens that while doing research into how I was going to bring out into the wide open spaces a brand new target who is the third highest executive of Delta Dental Plans Association – vice president in charge of marketing Tom Dolatowski – I was reminded of the number two DDPA official behind the shy president and CEO Kim E. Volk. Her name is Karron Callaghan, and she is vice president in charge of technology. While I am indeed interested in discussing Delta’s advertising ethics with Tom, such entertainment would be horse-play compared to the opportunity to discuss technology with Karron Callaghan. Callaghan knows all about Delta’s data-mining plans, including the current multi-million dollar expansion of office space in Okemos Michigan that includes a new 20,000 square foot data center. Data-mining is so important to Delta Dental that according to spokesman Ari B. Adler, even though 60 Delta employees are being laid off because of the loss of the contract with GM retirees, the data center will move on to completion. I’m sure it was a well-considered business move to increase Delta profits.

I should take this opportunity to point out that because of the McCarron-Ferguson Act of 1945, Delta Dental is allowed to make secret agreements with competing dental insurance companies to share dental claims information, and the FTC is powerless to step in to protect consumers. The FTC also cannot stop Delta Dental from mining dentists’ dental claims data, not to improve care, but to delay and deny reimbursements in infuriating ways that keep dental office staff busy with ever-changing, non-productive administrative chores that raise the cost of dentistry, thus decreasing access for everyone.

The data that Delta’s clever actuarial crew uses to cheat their clients was considered dentists’ proprietary information until the 1996 amendment to the Freedom of Information Act turned dentists’ private, Constitutionally-protected business information into “FOIA-disclosable information.” Yet in chapter 2 of Road Trip IV, titled “Common sense, Delta data mining and a modern sing along,” I will show you that Delta will not share valuable discoveries such as Dr. Anderson’s announcement, that are derived from dentists’ FOIA-disclosable information. Delta’s excuse is that our claims data, which Delta legally took from us and sorted according to NPI numbers, somehow turned into Delta Dental’s proprietary information.

Is Delta fair to dental patients who could otherwise benefit from modern, evidence-based research performed using data from millions of dental claims? Should Delta be allowed to continue to publish only results which are favorable to Delta Dental’s bottom line? Not any more, sports fans! In the spirit of the late infomercial pitchman Billy Maze, let me suggest that regardless whether the McCarran-Ferguson Act is repealed or not, I’ve got Delta trapped. Four months ago, in an introduction to a comment I posted on the PennWell forum titled, “I will hurt you, Delta Dental,” I confided, “I’ve been saving up for this opportunity a long time. I own Delta Dental.”

Now let me present Road Trip IV, starting with the Prologue I wrote two days before the 2008 National Benefits Conference commenced. I hope you find it inspirational.

ROAD TRIP IV – Prologue to a Show Down 8/13/08

I find it incredible that after two trips to Chicago and almost three years of increasingly aggressive efforts to engage ADA leadership in discussion about HIPAA, the NPI number, healthcare IT, the NADP, the firings of Bramson and Logan and other glaring examples of bureaucrats gone bad, ADA officials still choose to pretend I am invisible and cannot touch them. I would have thought only government representatives could be silent against damning evidence for so long. Friends, we have a stoic collection of world-class good ol’ boys in Chicago. Even though the only mission of the ADA is to serve dentists and their patients, our organization is by tradition, more secretive than the National Security Council. To achieve my goal of forcing transparency on the reticent ADA leaders in time for the national convention in San Antonio in October, I will pay Headquarters at least one more visit. My pleasure. This week, I hope to meet a few more friends to add to my spamgroup. If not, I hope to meet a few more targets. I’m ready for some new game with fresh, ambitious players. How about you?

I assume that when a new spammember reads the hard and direct criticism I write, he or she might say that if Darrell were more considerate and acted more like a professional, he might get his answers. I would say to the newbie that I tried polite. And I tried the ADA-approved hierarchical path that was established decades ago for common members like me to communicate with leadership. That is what began this adventure. I once went out of my way to express my concerns about HIPAA to my designated state representative in the proper manner. Within ten minutes he made it clear to me that tact simply sucks. Newbie, ADA members don’t have representatives. We have gate-keepers.

Most mid-level gate-keepers are still unaware that they can no longer insulate shy leaders. Command-and-control is so 1990s. This Friday and Saturday I will be attending the annual benefits conference at ADA Headquarters in Chicago for the second time. A year ago, this conference was the subject of “Road Trip I.” I attached the schedule of speakers. I had to email the ADA twice to obtain the schedule. The first time I sent the request to the members email discussion forum, and received no response at all. Who is in charge of that site anyway?

For those who followed RT II, my report on the evidence-based dentistry conference earlier this year, you will recall that I have developed a masochistic taste for asking difficult questions in front of large audiences in ADA Headquarters. You might also recall that at the very end of RT II, I was physically blocked by an ADA employee from criticizing managed care dentistry during the last open discussion period. I promise that I will never again tolerate such disrespect in silence. There will be noise. I could possibly be escorted out of ADA Headquarters before the end of the conference.

I’ve been working on a few ideas. For example, when I am given the right opportunity, I might ask one or more speakers to defend the NPI number. My question could go something like this: “Dr. Smith (ADA Trustee Charles Smith), I do not intend to apply for an NPI number for ethical reasons. Will the ADA support me in my decision?”

Just let Dr. Smith, or perhaps Dr. Jaworski (Chair, ADA Council on Dental Benefit Programs) try to answer that question. If either one of them concedes that ethics naturally compel the ADA to support my decision, the unprecedented honesty will undermine millions (?) of dollars and years of effort spent by the Department of Dental Informatics to promote the number. Even though such immediate good fortune for dental patients is unlikely, it would be incredibly entertaining to watch phony-balony careers collapse and heads tumble when HIPAA oafs collide with the Hippocratic Oath. Cognitive dissonance happens.

Smith and Jaworski are in too deep. They have no choice but to support the committee-approved status quo, regardless how foolish it will make them look in front of a hundred or so members. I expect to be served canned evasion which I will smash with a simple reply: “It seems wrong that the ADA would support the NPI number rather than a member and his patients.”

My imagination is busy. The abundance of deserving targets to choose will make this trip fun. I noticed, however, that the only insurance companies represented this year are BCBS and Delta Dental – two of my favorite proud, yet defenseless targets. That is down from five or six proud insurance companies that I hammered last year. My pleasure.

Here is an aggressive question that I am working on: “Mr. Smith (Mr. Chris Smith, Regence Blue Shield, Seattle, WA.), last year at this conference you said in a conversation that you did not understand my objection to the NPI number. I told you the NPI was tyranny. Since then, some of BCBS clients who had been satisfied with my care for a decade or more were forced by your NPI rule to find new dentists. I ask you, how important is a dental home compared to an arbitrary number that does nothing to improve the quality of care, yet increases the cost of providing dentistry?”

Or how about this stinker: “Dr. Anderson (Dr. Max Anderson, Delta Dental Plans Association, Oak Brook, IL), at the Southwest Dental Conference in Dallas this spring, Delta Dental employees who were promoting the NPI number assured me that it will be required for licensure in Texas within a year. Is that true?”

As always, I’ll be at the bar at the Ritz Carlton on Friday evening if anyone is interested in buying me a drink.

Whomever I am addressing, I hope you can appreciate that I feel uncomfortable opening these BCBSTX – Consumer negotiations to a wall of impersonal block letters. Understandably, I am more likely to be civil if I feel I am addressing a person rather than an anonymous fortification. Until I’m provided the name of a responsible BCBSTX representative, I will assign you the name “Wilma” because it is the name of an “over-all” supervisor I spoke with on the afternoon of May 1, 2008. She may have moved on by now. That is why it wouldn’t be fair to give her last name. For those in the Court who have already heard this story about Wilma, she’s the one who was eating what I think was a juicy peach when she picked up the phone at BCBSTX Headquarters. She is the first and only BCBSTX employee to almost answer my questions about the NPI number. I’ll share that fruitless exchange later as the opportunity presents. It is transcribed word-for-word from a microcassette recording of our conversation. Who knows? If there is sufficient interest, I’ll post the recording itself.

Why do I record telephone conversations with insurance companies? Apart from the security of hard documentation, I am entertained by samples of disingenuous in-your-face evasion – especially when I roll them out on a public forum such as this. And why shouldn’t I share? If a supervisor takes valuable time from her break to provide me information about their obscure policy, I cannot think of a valid reason why she wouldn’t want me to share the information with colleagues. After all, we don’t have a personal friendship, Wilma. We have a business relationship, and a bad one at that.

It is my opinion that the command-and-control tradition that still exists among insurance companies and other healthcare-related businesses is precisely what causes unenlightened gate-keepers, PR reps and high-level bureaucrats to mistakenly feel insulated from accountability to the doctors they serve. It’s as if members of the National Association of Dental Plans (NADP) have not yet heard of the Internet. Predictably, the endemic attitude is picked up by employees and leads to embarrassing attempts at evasion that mere stakeholders with lame business models would otherwise never attempt. I’m certain The Court will find what I offer both interesting and condemning.

Wilma, for the benefit of Texas dental patients, Texas dentists and BCBSTX, I would like to start by offering for discussion evidence that the unfair managed care business model of BCBSTX and other NADP members is being publicly undermined by several dentists on the Internet, including me. I’ll start by saying that I think our hatred for discount dentistry brokers arose decades ago because of past sins of companies like yours – an unfortunate part of dental history which is no fault of yours. I want you to know I and others understand that as an employee for a huge, insensitive company, you are given rules to follow and are powerless to change them. If you are told to defend the NPI number at all costs, even if you know that in doing so you cannot avoid coming across as a non-thinking employee, it’s your unwritten duty to sacrifice personal integrity if necessary for the good of BCBSTX. And we both recognize that as long as employees are told to remain anonymous, integrity is not likely to be a priority, Wilma.

I argue that BCBSTX’s problem with malfeasance emanates from deep inside the once insulated boardrooms occupied by leaders who are paid bonuses if they find clever ways to cheat clients and their dentists of money that is owed. Since the McCarran-Ferguson Act has not yet been repealed, it is left to states’ Attorneys General like Andrew Cuomo from New York and Greg Abbott from Texas to win suits long after insurance anti-trust crimes have occurred. This is far too inefficient. I think marketplace conversation with those you serve, such as this one, will help to correct NADP ethical lapses long before it costs states millions of dollars to prosecute them.

Jump in any time you feel like it, Wilma. Regardless, I’ll be back with more. Please don’t delete our discussion now. We’ve already come a long, long way under the radar as far as you know, and you have to agree that we really need to talk soon.

BCBSTX abandoned Facebook rather than face one dentist with issues. How brave is that?

For those like me who were hoping for unprecedented, transparent negotiations to finally begin between BCBSTX and Texas dentists on BCBSTX’s Facebook site, I have bad news. BCBSTX not only no-showed, but sometime last week, they took back their table in the middle of the night.

Let dental history show that the following was the last comment posted on BCBSTX’s Facebook before a very shy and anonymous BCBSTX official quietly shut it down:

“I don’t think Facebook is working out as well for BCBSTX as clueless officials were promised. Nevertheless, I appreciate the new forum for my unopposed opinions. I’ll keep working on stoic bureaucrats until I’m either respected or (temporarily) kicked off.

Your audience is still waiting for you to stand up for your boss, Wilma. Where are you?

Comments left on a blog can only mean that blog posts are worth commenting on. Great content and intelligent posts like this investigative Facebook and BCBS-TX report are what keeps readers coming back to the ME-P day after day.

If we both try really hard, how silly do you think we can we make this tantrum look on a professional forum, “Nancy”? Come on out onto the floor, Wallflower. Don’t be shy. Let’s dance.

This fresh attempt to salvage our Internet relationship is another in a long thread of attempts still to come, Nancy, and is a continuation of where we left off on July 24 in “10 days until Red Flags Rule – Again.”

I tried to post the following comment following your article with no byline:

“Thanks, DentalBogs.com, for the article describing social media and dentistry. Personally, I find that Facebook is a wonderful way to renew friendships with not only classmates from dental school but classmates all the way back to grade school.”

To give you a hint of the direction I’ll be taking a compliant TDA Facebook, my previous topic is titled, “Watch me stir up some silence.” I’m hoping to really piss someone off somewhere.

Consider this: In the last week, I have managed to not only aggravate people in Chicago Headquarters, but also in Austin and not for the first time ever, fellow members of my own Fort Worth District Dental Society.

I’m feeling gutsy now. I’m ready to take on the AARP.

Darrell

HITECH/HIPAA Breach notification

On August 18, American dentists will hear from HHS that HITECH-empowered HIPAA now requires that patients be notified if a breach includes their identifiers. Most will be surprised to learn that the notification requirement is nothing new. The law has been there for years. Besides the law, everyone has to admit that notifying those whose welfare is at risk is the only ethical thing to do, even if it bankrupts a practice. And that is the problem. Breach notification will bankrupt a dental practice.

The law has been around for years. It simply never was enforced by either HHS or CMS because it would be so devastating to small medical and dental practices. I assume that the shoddy enforcement is why the ADA did not see a need to distribute discouraging information about the HIPAA requirement. For some reason, the ADA supported the adoption of HIPAA. Some day we’ll know why.

This is not the first time I’ve brought up the breach notification topic on a TDA publication.

At the first of 2007, the TDA ventured into the blogosphere with “Ask a Colleague” Forum as part of the TDA’s Website. I began to take over the forum with a contribution posted on January 13, 2008 which I copied below. It is a snail-mail letter I received from President-elect Dr. John S. Findley, describing for the only time in ADA history, the ADA’s Data Breach protocol.

As you can see from the hard work put into the letter, it took a considerable amount of ADA dues to produce this response for only one ADA member. Nevertheless, my question was not taken lightly because they probably assumed it would show up again. And they were correct.

Even though the leaders failed to share it with other ADA members, before it was forgotten, it was cc’d to

Dr. S. Jerry Long, trustee, Fifteenth District

Dr. James Bramson, executive director

Ms. Mary Logan, chief operative officer

Ms. Tamra Kempf, chief legal counsel

Ms. Mary Kay Linn, executive director, Texas Dental Association

Two and a half years later, Findley’s letter is current enough to be posted with only minor changes. For example, Dr. James Bramson and Ms. Mary Logan no longer work for the ADA.

One more note about Dr. Findley’s response to my question, I did not misrepresent myself in my email to him that I had a computer stolen. He knew from six months earlier when I first emailed him my question that it was a hypothetical question about an obscure topic that ADA leaders did not want to talk about.

On January 8th, Dr. John S. Findley, President-elect of the American Dental Association, signed the letter below which defines a data breach, describes a dentist’s obligation under the law in Texas to notify patients involved and the penalty for failing to do so. This is the first time this information has been made available to dentists anywhere in the nation in the 12 years of the HIPAA rule. Dr. Findley and his team are to be congratulated for working through an arduous and unpopular task. It demanded courage.

I received your email of December 26 and regret to learn of the loss of your computer. I did inquire as to appropriate procedures upon the occurrence of such an event and am copying below an excerpt from the response of out legal department.

“It appears that under these circumstances the dentist may wish to notify affected patients that their information may have been compromised so that they can take necessary steps to protect themselves (i.e. cancel credit cards, notify social security about potentially stolen social security numbers…). (This communication is informational and personal consultation between the dentist and his or her attorney is recommended.) They should also check their state breach notification laws to determine if there is anything else that is required.

In this case, the Texas Identity Theft Enforcement and Protection Act (Texas Code Sec. 48 et seq) (the “Act”) covers data breach notification. The Act protects both “Personal Identifying Information,” which is defined as any information that alone, or in conjunction with other information, can be used to identify an individual and an individual’s:

The Act also protects “Sensitive Personal Information,” which is defined as an individual’s first name or first initial and last name in combination with any one or more of the following items, if the name and the items are not encrypted:

i) social security number;

ii) driver’s license number or government-issued identification number; or

iii) account number or credit or debit card number in combination with any required security code, access code, or password that would permit access to an individual’s financial account.

Sec. 48.102 of the Act creates a duty for businesses to protect and safeguard information through creating and implementing procedures for such purpose. If there is a breach in the security of information, the Act requires a business that maintains ‘Sensitive Personal Information” to notify the owners of such information as soon as possible that a breach has occurred. The Act specifies one of the following modes of notice to be provided:

1) written notice;

2) electronic notice, if the notice is provided in accordance with 15 U.S.C. Section 7001 (which basically requires that a consumer must consent to receiving such notice in electronic form); or

3) notice as provided by Subsection (f) (see below).

(f) If the person or business demonstrates that the cost of providing notice would exceed $250,000, the number of affected persons exceeds 500,000, or the person does not have sufficient contact information, the notice may be given by:

1) electronic mail, if the person has an electronic mail address for the affected persons;

2) conspicuous posting of the notice on the person’s website; or

3) notice published in or broadcast on major statewide media.

A person who violates the Act is liable to the state for a civil penalty of at least $2,000 but not more than $50,000 for each violation.”

The information pertaining to your question was found in the Identity Theft Enforcement and Protection Act, Chapter 48 of the Business and Commerce Act of Texas.

Now that the Texas Dental Association has opened a Facebook, it provides me an even more strategic hill to dominate. In my giddy moments, I sometimes imagine being General Patton using blitzkrieg tactics against the worn out Wehrmacht in southern France. “You hold ‘em by the nose and you kick ‘em in the ass…”

I announced my intentions to the TDA yesterday: “I seem to have narrowed this TDA Discussion Board (TDADB) (?) down to a monologue. That’s OK as well. I can handle it. If you haven’t noticed, the TDA’s page on Facebook is an information vacuum, and if nobody minds, I’ll fill it with my favorite information. Thanks. What an opportunity!” So far, nobody has objected.

Sometimes victory is as easy as raising a flag.

Darrell

Is the ADA responsive to membership?

Week 1

The email I copied below was sent today to the ADA. Is the ADA responsive to membership? It depends on the question and who’s asking it. (See “Transparency and the ADA – a dissecting experiment”)

“The ADA will be the profession’s prime resource for complying with these regulations.” – Dr. Robert A. Faiella, 1st District trustee. Dr. Faiella heads the Association’s Electronic Health Record Workgroup.

Dear ADA:

A week ago, I sent you three questions which are still awaiting a response.

1. If a dentist neither maintains nor sends digital patient records, is he or she a HIPAA-covered entity? The Fort Worth District Dental Society was recently provided information that appears to contradict that provided by the ADA.

2. Is encryption a viable security alternative?

3. If a computer is stolen in a burglary, compromised by a dishonest employee who sells IDs on the side, or otherwise hacked, will it not inevitably lead to bankruptcy even if the dentist reports the tragedy according to the letter of the law?

This email is being simulposted on TDA’s Facebook page, which currently has 196 members. So please respond promptly.

Many times in the past, I have broken dentistry-related news to my colleagues weeks, months and even years before the ADA News Online posted the ADA version of even feel-good topics the ADA considers safe to share with membership. For those who have followed me, you know that the ADA’s favorite topics don’t include most HIPAA or FTC-related news events. The ADA hardly reports about these at all. They became an embarrassment to our leadership long ago.

Please bear with me, because I’m still trying to make sense of the FTC’s final rule that was announced yesterday – which only awaits publication in the final register to become law. Like HHS’ forthcoming rule concerning HIPAA, the FTC’s covers a variety of data breaches including PHRs. Both rules were mandated under the American Recovery and Reinvestment Act as described in a very huge pile of paper that Congress quickly voted for a while back without reading. Last night, I found an early article about the FTC’s rule.

It appears that if a dentist is a HIPAA-covered entity, he or she won’t be fined by the FTC following an inspection brought about by a breach. HHS is taking over sole responsibility for that job. That’s good news, I guess. However, HHS fines are arguably moot if a breach occurs in a dentist’s office. Even if one follows the letter of the law, self-reporting a burglary could easily bankrupt a dentist. And what if it happens a second time? Some neighborhoods are like that.

From what I have gathered so far, the FTC, like the CMS a few weeks ago, is ceding breach jurisdiction of dentists’ offices to the HHS. However, I assume the Red Flags Rule still applies following only a couple more delays. But I am not entirely certain. In fact, I don’t even know if the news I am depending on from HealthDataManagement is itself reliable. Wouldn’t it be nice for those reading my report to enjoy real-time correction of rookie mistakes I am provably capable of making? We pay money to the ADA to keep us informed. Where are they? Why can’t the TDA Facebook be wiki?

The article, with no byline, is titled “FTC’s PHR Rule = Confusion.” The author clearly states that providers are not targeted by the new rule. “The rule does not apply to HIPAA-covered entities; the Department of Health and Human Services is writing separate rules governing the reporting of data breaches for these entities.” My bet is, HHS’ surprise won’t be good news for dentists. It never is.

Here is an excerpt from the article which explains that the FTC’s final rule applies to business associates rather than providers, yet it could still destroy innocent dentists’ reputations in their communities.

“Business associates of HIPAA-covered entities, which will be covered under HHS’ breach notification rule, also in some circumstances could fall under FTC’s rule. ‘If they experience a beach, they could be required to provide direct breach notification to their individual customers under the FTC’s rule,’ the final rule states. ‘At the same time, under HHS’ rule, they could be required to notify HIPAA-covered entities to whom they provide services, so that the HIPAA-covered entities could in turn notify individuals. In some cases, as discussed further below, this potential overlap could lead to consumers’ receiving multiple notices for the same breach.’”

This means that if a dentist uses a business associate such as Google Health, Microsoft’s HealthVault, or even an off-site digital records company which stores patients’ information, if such an FTC-covered business associate suffers a breach, the dentist will still have to notify patients, possible for the second time. If the negligent business associate fumbled more than 500 of the dentists’ patients’ information, local media must be notified. This means that if someone loses a laptop in New York, it could bankrupt a dental practice in Texas.

Here’s the big picture as I see it: ARRA makes the FTC the enforcer of security outside the walls of doctors’ offices while the HHS enforces HIPAA within. It’s sort of like the CIA’s jurisdiction compared to the FBI’s. For innocent dentists, it can still mean double jeopardy on a couple of levels.

(Note: I know very little about the reputation of the source, HealthData Management, but it appears to be an established Website.)

The Federal Trade Commission has released a final rule requiring vendors of personal health records–and entities that offer third-party PHRs–to notify consumers when the security of their PHR data is breached. Despite efforts of the FTC and the Department of Health and Human Services to harmonize separate rules governing notification of breaches, the FTC rule takes confusion to a new level and will require considerable study.

Example 1: Under the rule, vendors must notify consumer users of its PHR software in cases of a breach. But if a hospital, insurer or other entity offers a vendor’s PHR to consumers, then the vendor must notify the entity, which in turn must notify affected consumers.

Example 2: The rule does not apply to HIPAA-covered entities; the Department of Health and Human Services is writing separate rules governing the reporting of data breaches for these entities. Still, HIPAA-covered entities could fall under the FTC’s rules for PHR breaches. “Because the FTC’s rule does not apply to HIPAA-covered entities, it does not apply to PHRs that such entities offer their employees,” according to the FTC final rule. “However, if a HIPAA-covered health care provider or group health plan offers PHRs to employees because they also are patients of such health care provider or enrollees of such group health plan, then HHS’ rule would apply to the PHRs.”

Example 3: Although the FTC’s proposed rule made clear that it did not apply to HIPAA-covered entities, FTC explicitly excluded doctors from its rule, even if they are involved with PHRs, but with a twist. “The Commission agrees that, because health care providers such as doctors are generally HIPAA-covered entities, the FTC’s rule does not apply to them in such capacity. Thus, if a doctor’s medical practice offers PHRs to its patients, neither the doctor nor the medical practice is subject to FTC’s rule. However, if the doctor creates a PHR in a personal capacity, there may be circumstances under which the FTC’s rule would apply. For example, a non-practicing doctor may create and offer PHRs to the public as part of a start-up business venture. In this circumstance, the doctor is not acting in his or her capacity as a HIPAA-covered entity, and thus, the FTC’s rule would regulate the PHRs.”

Example 4: Business associates of HIPAA-covered entities, which will be covered under HHS’ breach notification rule, also in some circumstances could fall under FTC’s rule. “If they experience a beach, they could be required to provide direct breach notification to their individual customers under the FTC’s rule,” the final rule states. “At the same time, under HHS’ rule, they could be required to notify HIPAA-covered entities to whom they provide services, so that the HIPAA-covered entities could in turn notify individuals. In some cases, as discussed further below, this potential overlap could lead to consumers’ receiving multiple notices for the same breach.”

These four examples are from just the first dozen pages of the 88-page rule, available for viewing at ftc.gov/os/2009/08/R911002hbn.pdf. The rule soon will be published in the Federal Register, at which time it will become official.

The FTC final rule and HHS’ forthcoming rule, which covers a variety of data breaches including PHRs, were mandated under the American Recovery and Reinvestment Act.

Let me share with you a hobby of mine. I like to beat up on BCBSTX dental whenever possible. This afternoon, I spent far too much time posting my opinions of BCBSTX on Twitter. I go by the name “Proots,” and if you wish to hear the original screeches I sent @BCBSTX this afternoon, you can view them easily here: http://twitter.com/home . I started carving little chunks off of BCBSTX’s reputation about noon today.

Please allow me to share with you what I said to BCBSTX on Twitter in a reader-friendly, edited format:

The title of your hit #8 is: “BCBSTX must talk to D. Kellus Pruitt DDS” It was posted over a month ago. Do you believe it yet, cowards? I wish you’d take the “Texas” out of your name. You bring shame to my state. Why don’t you call yourself BCBSNY?

Did you think I was just kidding when I told you that you must talk to me, @BCBSTX? If you remain silent, I will continue to hurt you. Let me show readers how I’ve already hurt you, @BCBSTX. First of all, if one does a Twitter search of BCBSTX, like insurance shoppers are apt to do, I own 14 out of 15 comments. Here is the link:

The only other hit is @clintmiller – a client of BCBSTX who is asking for info. I figure if I tweet @BCBSTX 10 more times, it will push the BCBSTX client off of the first page. Then I can go golf.

How important are Internet searches to insurance companies these days, @BCBSTX? How much money do you think I have cost you?

I bet you’re pissed at D. Kellus Pruitt DDS, aren’t you @BCBSTX? You’d like to sue me just because I admit that I mean you cause you harm. If I were an official of the ADA – even a board member of my own dental society, I would not be at liberty to say the things I say without attracting a swarm of lawyers. How good is that?

But you cannot sue me, BCBSTX. For one thing, there is the 1st Amendment to the Constitution guaranteeing my right to freedom of speech. But even more daunting than that, you dare not bring publicity to the questions I ask because it would expose BCBSTX fraud against clients.

@BCBSTX dares not talk about the healthcare money squandered on a bi-monthly publication they published called “The NPI Times.” What about the harm @BCBSTX’s NPI policy caused their clients? Delta Dental rep. Dr. Maxwell Anderson says “changing dentists causes cavities.”

No. The @BCBSTX cowards are going to silently allow me to whittle on their reputation again and again – hoping I’ll leave. But I won’t. Every time I pass by, I slice off another chunk of @BCBSTX employees’ pride in their work because they know I am right. A former @BCBSTX employee and her husband were among the first to leave my practice because of her company’s NPI rule. It upset them both. They had been my patients for 15 years, but she had no choice. If she spent any money at my practice, her @BCBSTX insurance would not have paid her bill. Employees at @BCBSTX may actually know this gregarious person. She died of cancer about a year ago or so. It hurts. She was our friend. I’m sure you miss her also.

As soon as the @BCBSTX dental insurance policy expired following his wife’s death, the husband returned to my practice. My staff and I welcomed him back.

I’m about finished here, @BCBSTX. I haven’t kept count, but I’m certain that by now I own your first page on a Twitter search. Do you realize that no matter how deeply I cut into your reputation, @BCBSTX, nobody … NOBODY comes to your defense? Not even employees?

How much money do you spend on lobbyists to influence laws that favor your profits? How much money do you spend on listening to providers? Who is more important to dental patients? Lobbyists or dentists?… Wow! That one felt good. It cut deep!

Oh yea, one more thing @BCBSTX. Remember blocking me from following you on Twitter because you didn’t like the accountability I demanded? Then, if you recall, I also caused you to quickly abandon your Facebook account by merely asking questions about your NPI policy. “BCBSTX on Facebook” July 6, 2009.

So almost 3 months later, let me rephrase the question: I don’t think Twitter is working out well for @BCBSTX. When will you run and hide?

If I were a betting man, here is a wager I’d put $5 on: I think BCBSTX will abandon Twitter by March 1, 2010. You’d be foolish to bet against me because I think if the payoff was right, I could make it happen. I may force BCBSTX off Twitter just for grins anyway, as well as a service to the neighborhood.

Do you want to see what it takes for a Texas Dental Association member to suddenly get his butt kicked smooth off of the TDA Facebook? In addition to my usual “inflammatory comments” concerning BCBSTX and the NPI number that I posted on my state organization’s Facebook account – comments that up until two days ago have drawn profound silence from TDA officials for almost four years – TDA employee Lee Ann Johnson also found my efforts to stimulate participation on the TDA Facebook quite objectionable.

The Director of Member Services and Administration in TDA Headquarters in Austin objected to the parlor game I often play on Facebook that I call “Who is this?” As you can read below, she provided me a long list of crimes that occur when someone like me shares art with TDA members. Along with sections 6, 7, and 9, she copied Section 10 for me from the Facebook chapter on safety: “You will not use Facebook to do anything unlawful, misleading, malicious, or discriminatory.”

As anyone can see, I simply cannot allow such careless, hurtful and untrue allegations to stand unchallenged, and I don’t care who I hurt badly if I am not offered a humble apology really quickly.

To defend my professional reputation in this fine state which still respects fair play, I encourage you to follow this link to a game I led yesterday, elsewhere on Facebook centered in my hometown, Panhandle, Texas. It is titled, “Fred Hood, 1971.” Most TDA members will probably enjoy it. And according to Ms. Johnson, an unknown number of anonymous people will feel that the memory of Fred Hood was hurt by my unlawful, misleading, malicious and discriminatory game. It’s all about safety.

“Fred Hood, 1971” is not unlike the game I was leading on the TDA site. Once one witnesses the benevolent nature of the game, I think any reasonable person will certainly understand why I was shocked when I read Lee Ann Johnson’s reasons she found my efforts to encourage participation so objectionable, if not unlawful. TDA employee Johnson’s actions are clearly suspicious, and thanks to the transparency of the Internet that thousands are witnessing in real time, her actions are also public and will likely gain the attention they need really soon. The hard shell of the ADA has been cracked, and I intend to bust it wide open.

I’m proud to say that outside the walls of TDA Headquarters, “Who’s this” is very popular. I think the result vindicates me, and I’m afraid Lee Ann Johnson is the one who now looks oh so foolish.

Here are the reasons that she copied for banning me from the member-funded TDA Facebook, without the courtesy of an explanation.

3. Safety

• Section 6. You will not bully, intimidate, or harass any user.

• Section 7. You will not post content that is hateful, threatening, pornographic, or that contains nudity or graphic or gratuitous violence.

• Section 9. You will not offer any contest, giveaway, or sweepstakes (“promotion”) on Facebook without our prior written consent. If we consent, you take full responsibility for the promotion, and will follow our Promotions Guidelines and all applicable laws.

• Section 10. You will not use Facebook to do anything unlawful, misleading, malicious, or discriminatory.

You copied some courageous fighting words for a TDA employee, Ms. Lee Ann Johnson, current Director of Member Services and Administration.

In fairness to Ms. Johnson, who is probably an excellent and dedicated employee, it was undoubtedly not her decision to do something as drastic as depriving a TDA member of benefits purchased with his dues. I’m sure Johnson found herself in a difficult position. In all likelihood, her nameless boss said something like “I don’t’ care what you have to do, get that unprofessional [TDA member] off of our Facebook.”

Now then. Who is the anonymous bozo I demand to talk to in front of everyone? Whoever you are, come on out and receive your bustin’. And don’t forget. There’s a portrait and a $1 bill in it for you.

Even before the TDA opened their Facebook account, its leaders had countless opportunities to object to my direct methods of introducing transparency while I was using the TDA’s own Website. In the two years between April 27, 2007 and June 9, 2009, out of the 55 topics for discussion that were introduced on the “Ask a colleague discussion forum,” 50 are mine (90%).

Other than the occasional attaboys, nobody said a word to me – even when I criticized BCBSTX and the NPI number. And as readers will see in part 2, the blunt comments I made about BCBSTX and the NPI number that got me suddenly kicked off the TDA Facebook were not unlike those that cleared TDA censors years ago. So what changed? Facebook is transparent. The TDA discussion forum is not. The forum is not only restricted to TDA members, but it is laborious to get to. Since I stopped posting stuff, nothing is happening.

I’m certain that my comments raised tempers in TDA Headquarters, especially when I directly challenged TDA Presidents by name for excellent reasons. But then, just as now, not one official volunteered to meet me and talk about the TDA’s accountability problem. I can easily understand that in even the best organizations, it’s scary for entrenched bureaucrats to go toe-to-toe with consumers on a level field. It just doesn’t seem like a fair fight at all because in the best of all possible worlds, the customer is always right.

TDA officers weighed the risk of attempting to defend indefensible bad policies and chose to ignore me. Silence is a common bureaucratic default defense that worked well until the Internet came along. Like other traditional evasions, silence is obsolete.

Since most readers cannot log onto the TDA forum to read what my professional organization allows members to read but censors from access by the general public, here is my carefully selected opening question on the forum:

‘What should a dentist do if a computer is stolen from the office and it contains patients’ records?”

I posted it on August 10, 2007. Before I arrived, the TDA discussion forum was dormant – much like the now defunct BCBSTX Facebook, the active (?) TDA Facebook and the newly discovered Advance Oral Health Facebook which is dominated by Delta Dental.

Nobody from the TDA stepped forward to offer help. What if I’d really lost a computer? What if I had actually needed help from the TDA?

Below is my follow-up comment to the “Stolen computer” question. I posted it almost two years ago. As you read it, TDA leaders, you may mistake it for prophesy. Don’t be fooled. What we are witnessing is a plain ol’ logical conclusion – garden variety.

December 17, 2007 9:24 AM

In dysfunctional families, interpersonal problems often manifest as avoidance of painful issues which build to absurd proportions. If and when an issue blows up, innocent people often get hurt needlessly.

I found an article on darkreading.com last week titled: “Study: Breaches of Personal Data Now Prevalent in Enterprises.”

According to a national Ponemon study, 85% of “enterprises” have experienced breaches of personally identifiable information in the last 12 months.

What percentage of dental offices has experienced breaches? How many dental patients have their identities sitting on a shelf in any given pawn shop? How many dentists’ computers have been hacked? How many identities have been sold by dental office employees?

This is an issue that nobody wants to discuss. Will Texans wait until it blows up? Or do we bravely meet the issue head on? Let’s not be dysfunctional any longer.

There is no reason to store anything more than a reference number as an identifier on dentists’ computers. It is that simple. In an instant, virtually all liability is eliminated and our patients’ welfare is protected. (And HIPAA is almost entirely eliminated from the dental office.)

All we need is for someone to figure out how this can be done. Don’t ask me. I still use a pegboard, ledger cards and lots of carbon paper.

Let’s solve this problem now. If we allow this to blow, public confidence will evaporate. On the other hand, if the TDA leads the way.

Darrell

Unfortunately, discussion never took off at the TDA forum. Maybe my idea about getting around HIPAA is crappy. Like information about stolen computers, we just don’t know because such painful things are never discussed.

It was the sudden rejection that surprised me when Director of Membership Lee Ann Johnson kicked me off of the TDA Facebook. There was no warning from her at all. This tells me that Ms. Johnson did not want to be held accountable for her anonymous boss’s really bad command and control decision.

It was only after I was unable to log onto the TDA Facebook that Ms. Johnson informed me that my privilege had been revoked because among other things, I posted “inflammatory” comments about BCBSTX and the NPI number – even though the TDA has never complained about such comments before.

The comment below is even more critical of BCBSTX and the NPI number than what was censored from the TDA Facebook. I posted it on the TDA forum almost two years ago, and so far, nobody has complained. In fact, several TDA members approve of what I say about the funny business with BCBSTX and the NPI number. Yet a week ago, TDA employee Lee Ann Johnson was told to block me from the TDA Facebook, and to do it quickly.

On December 26th, 25 days after BCBSTX’s last deadline quietly came and went, I discovered the latest news about their arbitrary demand, unfairly imposed on unsuspecting Texas dentists. As you recall, BCBSTX threatened that after December 1st they would no longer process dental claims without an NPI number – regardless whether a dentist files electronically or with paper claims – and regardless whether there is a contractual relationship between BCBSTX and the dentist.

The news arrived in a cheery, full-color monthly newsletter that BCBSTX, a non-profit organization, proudly calls “The NPI Times.” The four-page brochure resembles expensive, professional-quality newsletters that some dentists use to attract patients. However, there is nothing attractive about the tone of “NPI Times.” The headline on the front page announces “All providers — including non-contracted providers — must share and use their NPI!” Providing balance to the harshness of the lead article, with the sincerity of a happy face sticker, is a cheerful “Best Wishes for a Healthy New Year!”

On the second page is an article with the title “Information Mismatches Are Delaying NPI Processing.” It lists how dentists’ mistakes on the NPPES are causing “duplicate communications, confusion and frustration.” Evidently, Texas dentists are not taking the NPI seriously. Their inattention to important details about the NPI number is at fault for the delay of numerous claims even before the next available deadline has a chance of staying put. In addition, the article tells dentists in detail what they have to do, step-by-step, in order to be paid as fast as they once were when a friendly postman was involved.

On page 3 there appears an article admonishing Texas dentists to “Make sure tomorrow’s claims get paid. Share your NPI with BCBSTX today!” At the bottom of the article, in bold italics, is written: Claims submitted to BCBSTX without an NPI as of January 7, 2008, will be rejected. Balancing the raw, unrestrained authority is a full-color photo of six happy people in business attire enthusiastically cheering with their clenched fists raised high above their heads as if they are celebrating a great victory. I suppose they are BCBSTX employees because they are not dressed like a dental staff. They look more like half a dozen MBAs – happy and cheering.

Texas dentists should pay close attention to ineptness of CMS employees, as well as BCBSTX’s wonder crew. Do you remember that we were once told that the NPI number will speed reimbursement of claims? As you read my first real-time dental history lesson below, take note of how badly the NPPES website and the NPI number have been managed so far. Now imagine that next year, it will be these same clumsy and ambitious non-thinkers who will determine how long dentists will have to wait before getting paid for work that already walked out the door. In business, that is power by default. Consider this: When an employee at CMS or BCBSTX screws up, it will always mean a delay in payment to the provider, who will then have to raise fees to cover the loss. There goes access to care – for what?

What is the incentive for the NPPES to be efficient when there is nothing at all holding down the cost of HIPAA compliancy? This kind of unfair business arrangement simply will not stand up in a free-market economy. It has collapsed in dentistry for natural reasons.

A Real-Time History Lesson: The rise and fall of the NPI in dentistry in the United States.

Have you noticed that the ADA and the TDA no longer promote the NPI? Months before our national organization abandoned the NPI, the TDA passed off the promotion of the number to employees of Delta Dental, who enthusiastically agreed to sign up TDA members during the annual convention in San Antonio. State delegates simply could not find any support at all for the NPI among TDA officers. Imagine that. Not a single Texas dentist would put his or her name behind the NPI effort. What does that say? God, I am proud to be a Texan dentist.

If you like watching history being shaped, I think you will find this interesting. If one goes to the ADA News’ A-Z Topics and selects “National Provider Identifier (NPI),” half-way down the page is a list of articles which have appeared in the ADA News since February 16th, 2004. That was the day that ADA reporter Craig Palmer broke the news about the NPI to ADA members when he posted an article titled “Feds set sights on national identifier system for health care providers.” Here is the first line of his article: “The government is preparing well in advance of May 23, 2007, to assign new numbers uniquely identifying all providers of health care services.”

So what happened on May 23rd, 2007? Nothing. The deadline was delayed for the first time. Perhaps the government did not start preparing soon enough. Or maybe it was simply a bankrupt national plan from the very beginning.

The titles of the ADA News’ articles outline the rise and fall of the NPI from the perspective of the ADA:

Then there appears evidence of problems caused by entrepreneurs selling “NPI kits” for $100 each to naïve dentists. Shortly after I posted notification about this concern on the now-closed ADA Forum, the following article appeared.

- Aug. 7, 2006 “No need to buy NPI kits”

For more than six months, the ADA Department of Dental Informatics was completely silent about the NPI number. Then, a week or so after the appearance of an Internet rumor about a delay in the May 23rd, 2007 deadline, there suddenly was a sense of urgency in an ADA News article.

- Mar. 5, 2007 “It’s time to get your NPI”

Over a month later, comes official news of the first of many delays – five weeks before the original May 23rd deadline. In comparison, this month, BCBSTX announced the delay in their deadline 25 days after the original. If BCBSTX moves so incredibly slow that they cannot admit a delay in their own “deadline” until three weeks after the date has past, how can Texas dentists possibly hope to be paid in a reasonable amount of time? Sorry. I was distracted by a huge chunk of absurdity. Back to history.

- Apr. 17, 2007 “NPI deadline delay”

Within a month, further problems with the NPI began to surface concerning inappropriate information appearing on the NPPES website – such as providers’ DEA numbers and social security numbers. After a long delay in mentioning this problem, it is given little importance by the ADA Department of Dental Informatics. I think history will call this the classic denial stage in the acceptance of the death of the NPI as an ADA concern.

So what happened to organized dentistry’s support for the NPI? Ultimately sharp legal minds, first in Austin and later in Chicago, recognized that the number’s promotion was indeed an egregious and regrettable grand mistake – the largest in ADA history. It is now unanimously, but quietly recognized that promoting the number is not only unethical, but it also carries certain liability because it lures otherwise satisfied patients from their dentists – not to improve their care, but rather to save money for insurance companies. This is probably no more than a coincidence, but this summer relevant research about the importance of dental homes began appearing in professional journals. This is about the same time that leadership on state and national levels of the ADA recognized that politicians, insurance representatives and healthcare IT vendors had methodically deceived them about the NPI – distracting them from the interests of dental patients. The research clearly shows that those who suffer from heart disease, kidney disease, diabetes or other chronic ailments die earlier if they do not receive proper dental care – gum disease, of course, being the usual culprit. It is logical that if insurance clients cannot visit the dentists and hygienists they choose, they have less incentive to receive the care that they clearly need on a consistent, long term basis. In effect, insurers like BCBSTX who require their clients to patronize only dentists who have arbitrary NPI numbers, as well as managed care dental insurers who have lists of preferred providers, shorten the life spans of frail clients in order to make more profit. In addition, if a client pays a premium for dental insurance, and never goes to a dentist on the list, an insurance company makes pure profit from money that might have otherwise purchased healthcare, or another need of the client. For this reason, there is a subtle disincentive for companies like BCBSTX and Delta Dental to enter into contracts with comfortable dental homes, in addition to the fact that they are also not the lowest bidders.

That is the way real-time dental history looks to me for the moment. I may not have everything correct, but since nobody has ever contested any of my views, I have to think I am getting deeper into the issue than anyone ever before. I always invite rebuttal, and just to make sure that I am fair, and to make this free forum a little more interesting, as well as historical, I am sending a copy of this essay to BCBSTX (npi@bcbstx.com) as an invitation to debate their plans for dentistry in Texas on TDAFF with any TDA member who wants to join in on real-time, open and no-spin discussion. I only hope that my email finds someone who has courage.

I think dentists across the nation are increasingly concerned about their patients’ welfare as well, and have issues that need to be discussed in their states. What are you waiting on? If not now, when?

As Dr. David May, President of the TDA bravely says, “Let’s talk.” God help me, but I sure am proud to be a Texan dentist.Darrell

Isn’t it a good thing Lee Ann Johnson prevented me from posting inflammatory stuff like this on the TDA Forum? She told me properly applied censorship protects TDA members.

I understand that there are well-meaning colleagues who are attempting to resolve the TDA’s exploding credibility problem using the ADA-approved channels that I found so insulting and ineffective years ago. I’m touched and indeed fortunate that there are those who believe in me enough to stand up for me. Eventually, they may make a difference. But here is something Headquarters should consider. I’m not waiting on anyone. Every time I see you falter, I’ll press on with renewed vigor. You cannot win from your position of defending BCBSTX and the NPI number, TDA. It is impossible.

D. Kellus Pruit; DDS

Next, part 3 of 3: My unanswered challenge to the leaders of the Texas Dental Association – February 19, 2008.

This is a follow-up to Ornery Friday’s “Accept a clue already, TDA – Part 2 – Where did we lose you, Austin?”

90% of Texas dentists don’t like BCBSTX

Attention, shy TDA leaders: I know image is very important to you, so I am suggesting that you should fully understand the results of a survey that was posted yesterday before you again order a defenseless and ill-equipped employee to step between a TDA member and BCBSTX. You sat back and allowed TDA Director of Membership Lee Ann Johnson to severely harm her own reputation just so that you would not have to dirty your hands. You’re sick. Forget about insulting me, I know how you were brought up, so what you think of me makes no difference at all. However, there is no excuse for treating devoted TDA employees with such disrespect. That kind of crap will come back to you. And here it comes.

Yesterday, Julie Frey of the Dental Practice Marketing and Management Blog posted the results of a survey sponsored by The Wealthy Dentist which questions dentists’ opinion of dental benefits companies like BCBSTX. The title gives away the results: “Dental Insurance: Few Fans among dentists.”

“To nine out of ten dentists in this survey, dental insurance companies feel like the enemy. Dentists feel like insurance companies care only about profits, and they resent the fact that many payouts haven’t risen in decades.”

90% of dentists don’t like dental insurance companies. I wonder how many don’t like you, TDA, now that you tipped your hand.

So what did we learn from my encounter with an anonymous Dallas County Dental Society official or three, grasshoppers? We learned that DCDS has a nice, quiet little Facebook that is protective, exclusive and well managed with no nonsense pride.

If a visitor gets out of line like as I did this week on the DCDS Facebook, he or she is immediately banished from the site with no warning, no explanation and no second chance. By design, it’s very difficult for an outsider from say, Fort Worth, to become accepted into the Dallas club that is kept below 100 fans. By lessening the risk of having loud dentists or other loose cannons as fans, they keep the site simple and manageable so that the Dallas County Dental Society Facebook can always look sterile.

When it comes to image, there’s no joking around in the Dallas County Dental Society.

Anyone out there wish to present a counter point? Most times when I invite rebuttals, nobody says a thing. So surprise me.

I know my question is off subject for this particular post on your Facebook, but nevertheless, knowing if we can count on BCBSTX insurance is arguably more important to clients and providers than finding buddies to walk with this fall.

———–

Now let’s see if BCBSTX will reply, ignore or delete my question. Is that not ornery?

“Doctors on Facebook risk compromising the doctor-patient relationship because many don’t use tight enough privacy settings. Researchers surveyed the Facebook activities of 405 postgraduate trainee doctors at Rouen University Hospital in France and found that almost three out of four had a Facebook profile. One in four logged on to the site several times a day, and half logged on several times a week.

Almost half believed that the doctor-patient relationship would be changed if patients discovered their doctor held a Facebook account, but three out of four said this would only happen if the patient was able to access their profile.”

For those with questions they are afraid to ask, I want to make this clear to my friends: That is so not me.

Recently, a few of my Facebook friends have privately asked me dental questions, and seemed to almost apologize for “bothering me.” It pleases me greatly to be able to help anyone. I’m from West Texas, not France.